Benefit Management Process Flow

How Does The Benefits Service Help?

1. Add and maintains all benefit plans available in your organization.
2. Records which employees are enrolled in which plans and at what coverage tier.
3. Stores employee contribution and employer contribution amounts as reference figures.
4. Tracks enrollment statuses (Awaiting Confirmation, Enrolled, Completed, Terminated, Waived Off, Declined, Withdrawn).
5. Manages dependent records and beneficiary assignments for enrolled employees.
6. Controls enrollment eligibility based on employee attributes such as designation, location, and employment type.
7. Define enrollment windows to facilitate employee benefit enrollment.
8. Generates reports showing enrollment statistics, beneficiary data, and plan-year summary.
   

Purpose: The Benefits module is designed specifically for benefits administration and record-keeping. It does not support payroll deductions, integrations with payroll systems or benefit providers for automated claims processing, or reimbursement management. However, benefits data can be exported and shared with payroll systems, insurance carriers, and other benefit providers.

Setting Up Benefits Service

Prerequisites

Before setting up the Benefits Service in Zoho People, please check the following: 

1. Make sure access to the benefits service is granted to authorized personnel. (Settings and Data). Benefits Administrators can be managed from Settings > Benefits > Permissions > Benefits Administrator tab. By default only the super administrator will have access. 
   
   
   
   
2. Ensure that the base currency is defined and add any additional currencies if needed (this data is shared with Compensation service in Zoho People). For example, if you are an Indian organization with US employees, then you might want to add USD currency. to check this, navigate to Settings > Benefits > Configuration > Currencies
   
   
3. Review default benefit categories and add any additional categories if needed. Navigate to Settings > Benefits > Configuration > Categories for list of default categories (11 in total). These categories will be available for selection when creating benefit plans. Click Add Category to add new categories if needed.
   
   
4. Import or add employee dependents data. Navigate to Operations > Benefits > Dependents tab > Add Dependents (or) More Options (ellipses icon) > Import Dependents. Or ask your employees to add/import the dependents data from the Benefits user service (left tab) > Dependents page.
   
   
   

Now let us proceed with the setup process for Benefits Service:

The following represents the typical sequence for configuring and managing employee benefits in Zoho People:

Add Benefits Providers →  Create Benefit Plans →  Configure Benefits Plan Year →  Configure Enrollment Windows →  Add or Import Employee Dependents →  Allow Employees to Add Dependents →  Employees Enroll in Benefit Plans

Step 1: Add Benefit Providers

what is a benefit provider?

A Benefits Provider is an insurance carrier, vendor, or third-party organization that offers the benefit plan. Before creating any benefit plans, you must add at least one provider. Every plan in Zoho People must be linked to a provider.

1. Navigate to Settings > Benefits > Configuration > Providers
   
   
   
   
2. To add a new provider, click on the Add Provider button
   
3. Fill in the required details, this includes:
   Name (mandatory)
   Provider ID (mandatory)
   Contact Email (mandatory)
   Contact Phone, Description, Address, Logo (non mandatory)
   
   
4. Click Submit to save.
   

Step 2: Create Benefit Plans

What is a Benefit Plan?

A Benefit Plan represents a specific insurance or benefit offering from a provider. Each plan belongs to a benefit category and defines how coverage is structured, who is eligible, and what the contribution amounts are. Plans must be Published before they can be added to a Plan Year or Enrollment Window.

1. Navigate to Settings > Benefits > Configuration > Plans
   
   
   
   
2. Click on the Add Plan button
   
3. Fill in the basic details and click Save to proceed.
   
   
   
   
4. On clicking Save, the detailed benefit plan addition page will appear. Fill in the following information: 
   Plan Details tab: 
   Name
   Short Description
   Plan Provider (Carrier)
   Currency (Currency for premium and contribution amounts. Defaults to organization's home currency (USD for U.S. companies))
   Plan ID (Plan ID provided by the provider for this plan. e.g., LIFE-MET-GROUP-01)
   Plan Summary (Short summary displayed in the employee self-service enrollment view.)
   Website (Link to the plan's official Summary of Benefits Coverage (SBC) or plan portal)
   Reference Documents to attach (Upload plan documents (Summary of Benefits, SBC, plan brochures). Up to 10 files)
   ACA eligibility (Toggle ON if this plan qualifies as minimum essential coverage under the ACA. This option is only displayed for medical plans)
   
   
   
   
   
5. Next, proceed to the Eligibility tab.
   Eligibility rules define which employees are eligible to enroll in a particular plan. When an employee opens the enrollment view, only plans for which they meet all eligibility criteria are displayed. This page includes the following options:
   Location: Restrict plan availability to specific office locations.
   Designation/Job Title: Limit to certain job roles.
   Employment Type: Full-time, Part-time, Contract, etc.
   Age Range: Specify minimum and maximum employee age for eligibility.
   Salary Range: Restrict enrollment to employees within a salary band.
   When do new employees become elegible?: Define a waiting period after hire before an employee becomes eligible (Available options: On the first day of the employee's joining month, immediately on the joining date, after a certain period)
   When do exiting employees loose elegibility?: Define when coverage ends relative to the employee's exit date.
   Proceed with configuring plan eligibility as required and mandated for the benefit plan you are adding.
   
   
   
   
6. Next, proceed to the Coverage Tiers tab.
   Each benefit plan supports up to four coverage tiers. These determine who can be covered under the plan and the corresponding contribution amounts. Choose between:
   Employee Only
   Employee + Spouse (can include domestic partner if required)
   Employee + Children (4 max)
   Employee + Family (4 max)
   
   
   
7. Next, proceed to the Contribution tab
   Here, For each coverage group, administrators configure:
   Employee contribution amount (flat amount or percentage of salary)
   Employer contribution amount (flat amount or percentage of salary)
   
   
   
8. Finally click Save and Publish (use the "Save" option if you want to publish at a leter time)
   

         -> Note on HSA | STD | LTD Benefit Plans

Important note regarding HSA (Health Savings Account) plans
if you select Health Savings Account (HSA) as the benefit category when adding a benefit plan, an additional required field appears: "Associated mandatory medical plans". Administrators must link the HSA plan to one or more qualifying high-deductible health plans (HDHPs). Employees can only enroll in the HSA plan if they are already enrolled in an associated medical plan. Refer screenshots below to understand this scenario.

  →   

 🇺🇸  IRS RULE:   Under IRS rules, employees must be enrolled in a qualified HDHP to contribute to an HSA. The HSA plan association in Zoho People enforces this requirement by checking the employee's medical plan enrollment before allowing HSA enrollment.

Step 3: Configure Benefit Plan Year

What is meant by "Benefit Plan Year"?
A benefit plan year is the defined time period during which specific benefit plans are active and available for employee enrollment. It determines the duration of the plan and when employees can enroll or make changes.
Benefit Plan Year in Zoho People can span from 3 to 12 months.

1. Navigate to Operations > Plans > Plan Year
   
   
   
   
2. Click on the Add Plan Year button and fill the following details:
   Name for benefit plan year - Descriptive label (e.g., '2025 Benefits Year', 'Benefits PY 2025-2026'). Must be unique.
   Description - Add information about the plan year.
   Start date - First day of the benefit period (e.g., January 1, 2026).
   End date - Last day of the benefit period (e.g., December 31, 2025).  
   Note: A span of 3-12 months is supported.
   Applicable locations - Associate the plan year with specific office locations. Leave blank to apply globally.
   
   
   
3. Next, navigate to the Included Plans tab. Here you will see the the various benefit cateogories and associated plans (benefits). Select the ones that you want to include in the plan year
   
   
4. Finally click Save to proceed.
   

You can add, enable/disable, clone, edit, or delete plan years from Operations > Benefits > Plans > Plan Year. Filter options are available too. Plan years can only be deleted if there are no enrollment windows created for it. Disabling a plan year will suspend new enrollments. 

TIP: Create the next plan year before the current one ends so that enrollment windows for the upcoming benefits year can be opened well in advance.

Step 4: Configure Enrollment Windows

What is an Enrollment Window?

An Enrollment Window is a specific time period during which eligible employees can actively enroll in benefit plans associated with a Plan Year. Enrollment Windows are the mechanism that controls when employees can make benefit elections.

1. Navigate to Operations > Enrollment tab
   
2. Use the Plan Year dropdown to select the plan year you would like to associate with enrollment window.
   
   
   
3. Click on the Add Enrollment Window button
   
4. In the "Add Enrollment Window" fill in the details:
   Enrollment window name - Descriptive name (e.g., '2026 Enrollment', '2026 New Hire Window – Q1').
   Description - Notes about the enrollment window purpose or instructions for employees.
   Plan effective year - Select the benefit plan year to associate with this enrollment window
   Applicable locations - Limit applicaiblity to employees of specific locations. Leave the field blank to make it availalbe for all locations.
   Start and end date of when employees can enroll - Set the date for when the enrollment window opens and closes.
   
   
5. Next, Proceed to the Included Plans tab, Here you can include, or exclude plans that will be available for enrollment for the employees (sub set of plans selected in the benefit plan year).
   
   
6. Finally, Click Save.
   

You can add, edit, delete, enable / disable enrollment windows from the Enrollment tab in Operations > Benefits page. Filters can be applied too. The Status of the Enrollment window will also be displayed in this page. These include:
Yet to Start - Window has been created but the Start Date has not been reached yet.
In Progress - Current date is between Start Date and End Date. Employees can actively enroll.
Closed - End Date has passed. No new enrollments accepted, but existing enrollments can remain in Awaiting Confirmation status if they are yet to be approved.
Completed - Administrator has completed the Complete Enrollments action. All pending (Awaiting Confirmation) enrollments are moved to Enrolled status.

Employee Enrollment

After setting up the plan year and opening the enrollment window, employees can proceed with their enrollments. Here is the step-by-step process of how employees enroll through an active enrollment window:

1. Employee logs in to Zoho People and navigates to Benefits > My Plans.
   
2. The system displays the current active enrollment window.
   
   
   
   
3. Employees can add any dependents they wish to include.
   
   
   
   
4. Employee clicks Enroll. The detailed Enrollment Window will appear, which will list the applicable benefit plans which employees can choose from. 
   Employees can proceed by clicking Enroll Now in the plans that they would like to take. 
   
   
   
   
5. Employee selects their desired Coverage Group (Employee Only, Employee + Spouse, etc.).
   
   
   
   
6. If the plan includes beneficiary designation (Life, AD&D), the employee selects dependents from their Dependents list and allocates coverage percentages.
   
7. Employee reviews the contribution amounts and any required associated plan enrollment (e.g., HSA requires HDHP enrollment).
   
   
   
   
8. A summary will be displayed at the bottom displaying all enrolled benefits and associated costs.
   
   
   
   
9. Employee submits the enrollment. A success message will be displayed.
   

→ Important Questions on Benefits Enrollment

Can an employee edit their benefit plan enrollment?
Until the enrollment window closes or the admin has manually completed enrollment, enrollment window can be edited. Use the Edit Enrollment option in the Benefits user service (left tab) > My Plans)

What if an employee wishes to withdraw an enrollment?
It is possible to withdraw an enrollment, until the enrollment is marked complete. Click on Edit Enrollment option in the Benefits user service (left tab) > My Plans and scroll down to the plan you wish to withdraw from and click Withdraw Plan button.

Important note regarding enrollment contribution update (post-enrollment)

For HSA, FSA, 401(k), Savings, and Pension plans, employees are permitted to update their contribution amounts after enrollment. This allows employees to adjust their pre-tax contribution levels without creating a new enrollment record. 
Employees can do this by navigating to Benefits >  My Plans > [Select Plan] > Update Contributions

 🇺🇸 For U.S: 401(k) plans, employees typically need to update their deferral percentage mid-year. The contribution update feature in Zoho People allows them to record this change. Ensure your payroll team is notified of contribution changes to apply the correct deferral in the payroll system.

Managing and Completing Enrollment

To see the status of an active enrollment window, navigate to Operations > Benefits > Enrollment tab.
Click on an active enrollment window. A detailed enrollment window overview will be presented:



This includes:

1. Associated plans and the number of employees awaiting approval, elegible for enrollment.
   
2. Enrollment progress bar.
   
3. Number of days left.
   
4. Option for the admin to complete enrollment. 
   Furthermore, navigating to the Employees tab within allows selecting individual plans to see the associated employees, their enrolled date, total contribution. Administrators can Uneroll Employees from here if required. 
   
   

To complete enrollment, select an indivual enrollment window and click on the Complete Enrollment button. This will update the status from in-progress to Completed in the Operations > Enrollment tab.

Benefits Reports | Exporting Data

Benefits service in Zoho People includes three reports. Within each report use the Filter option ( ) to control the data displayed. E.g, to view only the list of medical plans within a plan year and the corresponding contribution data. 
Click on the More option (ellipses icon  ) to access the Export option. Data can be exported for sharing with service providers, government agencies (such as IRS), insurance carriers, health care administrators, etc.

1. Plan Year Enrollment
   Description:
   Shows all enrollments for a selected plan year, grouped by plan and status.
   Example Use Case:
   Annual enrollment summary; ACA offering records.
   
   
   
   
2. Plan Enrollment
   Description: 
   Detailed enrollment records for a specific plan, including employee names, coverage groups, contribution amounts, and effective dates.
   Example Use Case:
   Share with insurance carriers for enrollment verification.
   
   
   
   
3. Beneficiaries
   Description:
   Lists all beneficiary designations across enrolled plans, including allocation percentages.
   Example Use Case:
   Life insurance beneficiary audit; ERISA compliance.